简介：摘要中华医学会、中华医学会神经病学分会主办的"第19次中国脑血管病大会"于2019年4月11—13日在南京召开。本次会议邀请了国内外脑血管病的临床和基础研究专家，介绍了国内外最新的研究进展和临床研究、诊疗指南。尤为精彩的是疑难型脑血管病的病例讨论。

简介：摘要新冠状病毒病(COVID－19)自2019年12月在我国发现以来，目前已在全球213个国家爆发，540多万人受累，并导致近35万人死亡，WHO将其定义为全球大流行。COVID－19除了表现为呼吸系统病变，在重症患者还可能合并有其他脏器损伤，部分患者可出现肾脏损伤，如发生血尿、蛋白尿，血尿素氮或血清肌酐水平升高等；危重症患者中急性肾损伤的发生率较高且影响患者预后。本文将从COVID－19患者肾损伤流行病学及临床特点、发病机制、病理表现、治疗和预后等方面综述，希望能从肾脏病专科角度为COVID－19的防控提供相关信息。

简介：摘要2019冠状病毒病（COVID-19）在我国暴发以来，目前进入全民防控阶段，其主要传染源是新型冠状病毒肺炎患者，但无症状感染者也可能成为传染源，因孕妇机体处于免疫抑制状态，对呼吸道病原体更易感，易发展为重症。疫情期间，孕产妇仍需要至医院进行必要的产前检查或终止妊娠等产科干预。针对以上特殊性，首都医科大学附属北京佑安医院制定了在疫情之下孕产妇的诊疗流程，调整和优化门诊产检及住院治疗过程，力求把疫情对孕产妇诊疗的影响降到最低，保证母婴健康。同时制定医护人员相关防护流程，有效避免院内感染发生，为疫情期间产科诊疗方案的制定提供参考。

简介：AbstractCoronavirus disease (COVID-19) was first diagnosed in Wuhan in December 2019. The World Health Organization defined the subsequent outbreak of COVID-19 worldwide as a public health emergency of international concern. Epidemiological data indicate that at least 20% of COVID-19 patients have severe disease. In addition to impairment of the respiratory system, acute kidney injury (AKI) is a major complication. Immune damage mediated by cytokine storms and concomitant AKI is a key factor for poor prognosis. Based on previous experience of blood purification for patients with severe acute respiratory syndrome and Middle East respiratory syndrome combined with clinical front-line practice, we developed a blood purification protocol for patients with severe COVID-19. This protocol is divided into four major steps. The first step is to assess whether patients with severe COVID-19 require blood purification. The second step is to prescribe a blood purification treatment for patients with COVID-19. The third step is to monitor and adjust parameters of blood purification. The fourth step is to evaluate the timing of discontinuation of blood purification. It is expected that blood purification will play a key role in effectively reducing the mortality of patients with severe COVID-19 through the standardized implementation of the present protocol.

简介：摘要原发性甲状腺淋巴瘤（primary thyroid lymphoma, PTL）在人群中罕见，随着粗针穿刺活检技术诊断效率的提高，PTL手术治疗的作用减小，但在不能明确病理亚型时手术活检仍是不可取代的，PTL的预后主要和病理类型及疾病的分期有关。

简介：摘要目的分析新型冠状病毒肺炎(COVID-19)老年患者临床特征及预后影响因素，为临床诊治提供参考依据。方法回顾性分析确诊COVID-19住院患者109例，其中老年组39例，非老年组70例，比较两组的各项临床资料及预后。结果COVID-19老年组发生重型、危重型比例高于非老年组[48.7%(19/39)]比[15.7%(11/70)]，P＝0.032。老年组有慢性基础病患者比例明显高于非老年组[84.6%(33/39) ]比[30%(21/70)]，P＝0.003。老年组伴有胸闷15例(38.5%)、喘憋12例(30.8%)高于非老年组胸闷13例(18.6%)、喘憋3例(43%)，P<0.05。实验室检查指标中老年组外周血淋巴细胞绝对计数比非老年组明显降低(P＝0.029)。老年组C-反应蛋白、粒淋比(NLR)比非老年组明显升高(P<0.001)。老年组丙氨酸氨基转移酶(ALT)、谷氨酸氨基转移酶(AST)、白蛋白(ALB)、肌酐(CREA)、肌酸激酶(CK)、肌红蛋白(MYO)异常值高于非老年组(P<0.05)。其中年龄、基础病、NLR是影响预后的独立危险因素。结论COVID-19老年组患者常合并多种基础病，更易出现心、肝、肾功能异常，更易发展为重型、危重型病例。影响预后的因素包括年龄大于60岁、有基础病和血清NLR水平。

简介：AbstractBackground:The ongoing new coronavirus pneumonia (Corona Virus Disease 2019, COVID-19) outbreak is spreading in China, but it has not yet reached its peak. Five million people emigrated from Wuhan before lockdown, potentially representing a source of virus infection. Determining case distribution and its correlation with population emigration from Wuhan in the early stage of the epidemic is of great importance for early warning and for the prevention of future outbreaks.Methods:The official case report on the COVID-19 epidemic was collected as of January 30, 2020. Time and location information on COVID-19 cases was extracted and analyzed using ArcGIS and WinBUGS software. Data on population migration from Wuhan city and Hubei province were extracted from Baidu Qianxi, and their correlation with the number of cases was analyzed.Results:The COVID-19 confirmed and death cases in Hubei province accounted for 59.91% (5806/9692) and 95.77% (204/213) of the total cases in China, respectively. Hot spot provinces included Sichuan and Yunnan, which are adjacent to Hubei. The time risk of Hubei province on the following day was 1.960 times that on the previous day. The number of cases in some cities was relatively low, but the time risk appeared to be continuously rising. The correlation coefficient between the provincial number of cases and emigration from Wuhan was up to 0.943. The lockdown of 17 cities in Hubei province and the implementation of nationwide control measures efficiently prevented an exponential growth in the number of cases.Conclusions:The population that emigrated from Wuhan was the main infection source in other cities and provinces. Some cities with a low number of cases showed a rapid increase in case load. Owing to the upcoming Spring Festival return wave, understanding the risk trends in different regions is crucial to ensure preparedness at both the individual and organization levels and to prevent new outbreaks.

简介：摘要目的对安徽省新型冠状病毒肺炎(COVID-19)病例标本进行新型冠状病毒核酸检测，分析各类标本检出情况，为病例确诊及判断样本带毒风险提供依据。方法采用实时荧光RT-PCR方法检测197病例466份临床标本，病毒靶基因为ORF1ab和N，应用卡方检验探讨不同标本在不同临床分型和发病时间核酸阳性率差异。结果COVID-19病例痰液标本在各临床标本中阳性率最高94.67%(160/169)，其次为咽拭子88.83%(159/179)，血清6.78%(4/59)，全血标本阳性率较低，为5.08%(3/59)。发病0～7 d普通型患者咽拭子阳性率和痰液阳性检出率差异有统计学意义(χ2＝8.994，P＝0.003)。结论痰液标本核酸阳性检出率高于咽拭子标本，COVID-19病例血液标本存在病毒核酸，存在感染风险。

简介：摘要目的本研究旨在评估REF-XT01型尿酸测试仪检测血尿酸浓度的准确性，以判断该尿酸测试仪检测结果能否用于指导痛风患者降尿酸药物的调整。方法对青岛大学附属医院痛风病临床医学中心就诊的1 551例受试者，空腹采集静脉血，用全自动生化分析仪测定血尿酸浓度，同时采集指尖末梢血用REF-XT01型尿酸测试仪测定血尿酸浓度。应用线性回归、组内相关系数(ICC)、Bland-Altman分析法评估全自动生化分析仪血尿酸浓度(sUABA)检测值和尿酸测试仪血尿酸浓度(sUAUM)检测值间的相关性。使用受试者操作特性曲线(ROC曲线)，评估sUAUM能否用于指导痛风患者的降尿酸用药。结果回归分析表明sUABA和sUAUM之间有良好的相关性，Y＝0.875X＋39.525(r＝0.84, P<0.01)；ICC为0.829(95%CI 0.814～0.844, P<0.01)；Bland-Altman图显示sUABA和sUAUM具有较好的一致性，绝对偏差95%一致性界限(95% LoA)-143.4～114.5 μmol/L，平均偏差-14.4 μmol/L。以300 μmol/L作为尿酸测试仪的检测临界值，灵敏度为96.61%，特异度为48.81%，ROC曲线下面积(AUC)为0.926(P<0.01)，而以360 μmol/L作为检测临界值，灵敏度为90.98%，特异度为66.78%，AUC为0.914(P<0.01)。结论REF-XT01型尿酸测试仪具有较高的精确度，其检测血尿酸数值可用于指导痛风患者降尿酸药物的调整。

简介：摘要目的探讨具有广谱中和活性的患者DRVI01血浆来源的HIV-1B′亚型毒株抵抗VRC01抗体中和的机制。方法比较同期感染相同亚型且对VRC01抗体敏感的病毒序列，结合文献报道筛选可能影响VRC01中和作用的关键氨基酸，通过定点突变、不同来源膜蛋白序列交换，验证这些位点氨基酸对VRC01抗体中和作用的影响。结果位于gp120的LoopD区E279D、R282K和V5区N460A、N463Q单点突变，逆转了病毒对VRC01中和敏感性。上述2个或3个位点联合突变后的毒株与单点突变毒株比较，对VRC01抗体中和敏感性明显增强。与文献报道不同，N276糖基化位点突变并未改变毒株对VRC01的敏感性。结论具有广谱中和活性患者DRV01血浆来源的HIV-1B′亚型毒株主要通过LoopD区D279、K282和V5区N460、N463突变，抵抗VRC01抗体的中和作用。

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简介：摘要目的探讨COVID-19康复者恢复期血浆及COVID-19静注人免疫球蛋白(human intravenous immunoglobulin，IVIG)(COVID-19-IVIG)IgG及亚类的水平。方法选择2020年2月至3月国药集团武汉血液制品有限公司采集的COVID-19康复者恢复期血浆及制备的COVID-19-IVIG作为研究组，选择健康者单采血浆及IVIG作为对照组。采用免疫比浊法检测并比较免疫球蛋白(IgG、IgA、IgM)及IgG亚类水平。分析COVID-19-IVIG中IgG亚类与其他蛋白之间的相关性。结果健康者单采血浆的IgG3、IgG4水平显著高于恢复期血浆(P<0.05)，但IgG1、IgG2水平差异无统计学意义(P>0.05)。恢复期血浆IgM水平与血型〔相关系数(r)＝0.649〕、抗体效价(r＝0.696)呈正相关(P<0.05)，IgG1(r＝0.745)、IgG2(r＝0.952)水平与IgG呈正相关(P<0.05)。COVID-19-IVIG的IgG1/∑4i=1 IgGn显著高于恢复期血浆(t＝3.633，P<0.05)，而IgG4/∑4i=1 IgGn显著低于康复者混合血浆(t＝-4.899, P<0.05)，两组间IgG2/∑4i=1 IgGn和IgG3/∑4i=1 IgGn差异无统计学意义(t值分别为-0.974和-0.280，P值均大于0.05)。COVID-19-IVIG与IVIG的IgG亚类分布差异无统计学意义(P>0.05)。在COVID-19-IVIG中，仅IgG2水平与α2巨球蛋白呈负相关(P<0.05)。结论恢复期血浆IgG亚类水平与健康者单采血浆有一定差异。COVID-19-IVIG制备过程中存在IgG亚类水平的变化，COVID-19-IVIG IgG亚类齐全，与IVIG IgG亚类水平相近。

简介：AbstractThe coronavirus disease 2019 (COVID-19) pandemic has highlighted the practice of infectious diseases biobanking, as well as existing challenges and opportunities. Thus, the future of infectious diseases biobanking in the post-pandemic era, shall not be an "entry-level version" of its counterpart in non-communicable diseases and large population cohorts, but incorporate the lessons learned. Biobanks constitute a critical research infrastructure supported by harmonized practices through the implementation of international standards, and perceived within the broader scope of healthcare's intersection with research. This perspective paper considers the barriers in biobanking and standardization of practices, as well as the emerging opportunities in the field.

简介：AbstractBackground:The ongoing COVID-19 pandemic hit South America badly with multiple waves. Different COVID-19 variants have been storming across the region, leading to more severe infections and deaths even in places with high vaccination coverage. This study aims to assess the spatiotemporal variability of the COVID-19 pandemic and estimate the infection fatality rate (IFR), infection attack rate (IAR) and reproduction number (R0) for twelve most affected South American countries.Methods:We fit a susceptible-exposed-infectious-recovered (SEIR)-based model with a time-varying transmission rate to the reported COVID-19 deaths for the twelve South American countries with the highest mortalities. Most of the epidemiological datasets analysed in this work are retrieved from the disease surveillance systems by the World Health Organization, Johns Hopkins Coronavirus Resource Center and Our World in Data. We investigate the COVID-19 mortalities in these countries, which could represent the situation for the overall South American region. We employ COVID-19 dynamic model with-and-without vaccination considering time-varying flexible transmission rate to estimate IFR, IAR and R0 of COVID-19 for the South American countries.Results:We simulate the model in each scenario under suitable parameter settings and yield biologically reasonable estimates for IFR (varies between 0.303% and 0.723%), IAR (varies between 0.03 and 0.784) and R0 (varies between 0.7 and 2.5) for the 12 South American countries. We observe that the severity, dynamical patterns of deaths and time-varying transmission rates among the countries are highly heterogeneous. Further analysis of the model with the effect of vaccination highlights that increasing the vaccination rate could help suppress the pandemic in South America.Conclusions:This study reveals possible reasons for the two waves of COVID-19 outbreaks in South America. We observed reductions in the transmission rate corresponding to each wave plausibly due to improvement in nonpharmaceutical interventions measures and human protective behavioral reaction to recent deaths. Thus, strategies coupling social distancing and vaccination could substantially suppress the mortality rate of COVID-19 in South America.

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简介：摘要目的探讨子宫动静脉畸形采用子宫动脉介入栓塞治疗的临床效果。方法选取2014年4月至2019年12月在我院就诊并接受治疗的19例子宫动静脉畸形患者作为研究对象，均给予子宫动脉栓塞术（UAE）治疗，评价治疗效果和患者预后。结果19例患者中有15例患者均一次性UAE治疗止血成功，术后患者主诉右下腹轻度疼痛不适，术后2～5 d症状消失，剩余4例治疗后阴道仍有出血，其中2例患者转手术治疗，另2例给予保守治疗后好转。19例患者术后均未发生严重并发症。结论子宫动静脉畸形虽然在临床较为少见，但很容易引起严重后果，UAE治疗子宫动静脉畸形是一种微创、高效且可重复的治疗方式，对无手术禁忌症者可作为首选的治疗方式。

简介：AbstractSince December 2019, a pneumonia caused by a new coronavirus, i.e. COVID-19 occurred in Wuhan, Hubei Province, China. Although the epidemic in China has been bought under control, the global COVID-19 situation is still grim. Severe traumatic brain injury (TBI), as one of critical conditions in the department of neurosurgery, requires an early and effective treatment, especially surgery. There were currently no reliable guidelines on how to perform perioperative protection in TBI patients with suspected or confirmed coronavirus infection. According to the corresponding treatment regulations and guidelines issued by the authorities, we summarized the management strategy of TBI patients in perioperative period during the COVID-19 outbreak based on medical and nursing practice, in order to provide a reference for clinicians.

简介：摘要目的总结PCDH19基因嵌合突变导致的男性癫痫患儿临床表型和基因突变特点。方法分析3例男性PCDH19基因嵌合突变患儿的临床特点，采用微滴数字PCR进行嵌合突变定量分析，并进行相关文献复习。结果3例患儿起病年龄分别为生后5个月、9个月和6个月；2例病程中仅出现局灶性发作，1例病程中出现多种发作类型；3例发作均有丛集性；2例有热敏感；2例有智力障碍，1例有孤独症样表现。1例临床表型符合Dravet综合征诊断。3例患儿PCDH19基因突变位点分别为c.317T>A(p.M106K)、c.158dupT(p.D54Gfs*35)和c.1639G>C(p.A547P)，且证实为新生突变，外周血突变等位基因比分别为81.18%、37.08%和77.64%，其中1例患儿的多组织样本的突变等位基因比为78.67%～98.46%。文献检索发现PCDH19基因嵌合突变所致男性癫痫共11例，起病年龄范围为出生后5～31个月，9例有局灶性发作，其中3例仅表现局灶性发作；4例有全面强直阵挛发作；6例有≥2种发作类型；11例发作均有丛集性；9例有热敏感；7例有智力障碍；5例有孤独症谱系障碍。结论PCDH19基因嵌合突变导致男性癫痫的临床特点为癫痫发作具有丛集性和热敏感特点，以局灶性发作最常见，多伴不同程度智力障碍，部分患儿有孤独症谱系障碍。

简介：摘要Corona virus disease 2019 (COVID-19) is a new disease characterized by lung damage and involvement in multiple tissues and organs in the whole body. Some of the patients may have long-term impairment and dysfunctions, including pulmonary fibrosis, heart, liver, kidney, nerve and immune system. Rehabilitation has certain beneficial effect in the acute stage, and especially in the recovery stage, including improving respiratory function, exercise endurance, self-care in daily living activities, as well as psychological support, etc. Rehabilitation is not offside or absent. A reasonable rehabilitation program needs scientific research to avoid arbitrary conclusions.

简介：摘要The rapid evolution of the health emergency linked to the spread of severe acute respiratory syndrome coronavirus 2 requires specifications for the rehabilitative management of patients with coronavirus disease 2019 (COVID-19). The symptomatic evolution of patients with COVID-19 is characterized by 2 phases: an acute phase in which respiratory symptoms prevail and a postacute phase in which patients can show symptoms related to prolonged immobilization, to previous and current respiratory dysfunctions, and to cognitive and emotional disorders. Thus, there is the need for specialized rehabilitative care for these patients. This communication reports the experience of the San Raffaele Hospital of Milan and recommends the setup of specialized clinical pathways for the rehabilitation of patients with COVID-19. In this hospital, between February 1 and March 2, 2020, about 50 patients were admitted every day with COVID-19 symptoms. In those days, about 400 acute care beds were created (intensive care/infectious diseases). In the following 30 days, from March 2 to mid-April, despite the presence of 60 daily arrivals to the emergency department, the organization of patient flow between different wards was modified, and several different units were created based on a more accurate integration of patients′ needs. According to this new organization, patients were admitted first to acute care COVID-19 units and then to COVID-19 rehabilitation units, post-COVID-19 rehabilitation units, and/or quarantine/observation units. After hospital discharge, telemedicine was used to follow-up with patients at home. Such clinical pathways should each involve dedicated multidisciplinary teams composed of pulmonologists, physiatrists, neurologists, cardiologists, physiotherapists, neuropsychologists, occupational therapists, speech therapists, and nutritionists.